2020年最新JBJS文献——非创伤性股骨头坏死：我们今天的立场(研究进展)？：5 年更新

非创伤性股骨头坏死：我们今天的立场(研究进展)？：5 年更新

译者：陶可（北京大学人民医院骨关节科）

摘要：

➢ 临床医生应高度警惕高危患者（使用皮质类固醇、过量饮酒、患有镰状细胞病等），以便及早诊断出股骨头坏死。

➢ 非手术治疗方式在阻止（股骨头坏死）进展方面通常是无效的。因此，当人们试图保留天然（髋）关节时，非手术治疗在早期是不合适的，除非在极少数情况下，小尺寸、位于内侧的病变可能无需手术即可愈合。

➢ 早期病变应尝试保髋手术，以保留住股骨头。

➢ 基于细胞疗法的（髋）关节保留手术继续显示出有希望的结果，因此应被视为可能改善临床结果的辅助治疗方法。

➢ 在骨坏死的情况下全髋关节置换术的结果非常好，结果与潜在诊断为骨关节炎的患者的结果相似。

文献出处：Michael A Mont, Hytham S Salem, Nicolas S Piuzzi, Stuart B Goodman, Lynne C Jones. Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today?: A 5-Year Update. Review, J Bone Joint Surg Am. 2020 Jun 17;102(12):1084-1099.doi: 10.2106/JBJS.19.01271.

Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today?: A 5-Year Update

Abstract

➢ Clinicians should exercise a high level of suspicion in at-risk patients (those who use corticosteroids, consume excessive alcohol, have sickle cell disease, etc.) in order to diagnose osteonecrosis of the femoral head in its earliest stage.

➢ Nonoperative treatment modalities have generally been ineffective at halting progression. Thus, nonoperative treatment is not appropriate in early stages when one is attempting to preserve the native joint, except potentially on rare occasions for small-sized, medially located lesions, which may heal without surgery.

➢ Joint-preserving procedures should be attempted in early-stage lesions to save the femoral head.

➢ Cell-based augmentation of joint-preserving procedures continues to show promising results, and thus should be considered as an ancillary treatment method that may improve clinical outcomes.

➢ The outcomes of total hip arthroplasty in the setting of osteonecrosis are excellent, with results similar to those in patients who have an underlying diagnosis of osteoarthritis.

Figs. 1-A and 1-B Small-diameter CD for ONFH. A trocar is introduced into the necrotic lesion using light mallet blows (Fig. 1-A) under fluoroscopic guidance (Fig. 1-B).

图1 用于股骨头坏死 ONFH 的 1-A 和 1-B 小直径髓心减压CD术。在透视引导下（图 1-B）使用轻槌敲击（图 1-A）将套管针引入坏死病变区域。

Fig. 2 Aspiration of bone marrow from the iliac crest for subsequent processing and implantation following femoral head CD.

图 2 从髂嵴抽吸骨髓，用于股骨头髓心减压CD术后的后续处理和植入。

Fig. 3 The lightbulb technique—creation of a cortical window at the femoral head-neck junction for evacuation of necrotic tissue and replacement with a bone graft.

图 3 灯泡技术——在股骨头颈交界处创建一个皮质窗口，用于清除坏死组织并用骨移植物替代。